Evaluation of medication-related clinical decision support alert overrides in the intensive care unit

• Published in: Journal of critical care 2017-06, Vol.39, p.156-161
• Main Authors: Wong, Adrian, Amato, Mary G, Seger, Diane L, Slight, Sarah P, Beeler, Patrick E, Dykes, Patricia C, Fiskio, Julie M, Silvers, Elizabeth R, Orav, E. John, Eguale, Tewodros, Bates, David W
• Format: Article
• Language: English
• Subjects: Adverse drug event; Aged; Allergies; Cardiovascular disease; Clinical decision making; Clinical decision support; Critical Care; Critical Care - statistics & numerical data; Decision making; Decision support systems; Decision Support Systems, Clinical; Drug therapy; Drug-Related Side Effects and Adverse Reactions - etiology; Emergency communications systems; Female; Geriatrics; Humans; Intensive care; Intensive Care Units - statistics & numerical data; Kidneys; Male; Medical Order Entry Systems - statistics & numerical data; Medication Errors - statistics & numerical data; Middle Aged; Patient safety; Quality of care; Quantitative analysis; Side effects
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2017.02.027

Abstract Purpose Medication-related clinical decision support (CDS) has been identified as a method to improve patient outcomes but is historically frequently overridden and may be inappropriately so. Patients in the intensive care unit (ICU) are at a higher risk of harm from adverse drug events (ADEs) and these overrides may increase patient harm. The objective of this study is to determine appropriateness of overridden medication-related CDS overrides in the ICU. Materials and methods We evaluated overridden medication-related alerts of four alert categories from January 2009 to December 2011. The primary outcome was the appropriateness of a random sample of overrides based on predetermined criteria. Secondary outcomes included the incidence of adverse drug events (ADEs) that resulted from the overridden alert. Results A total of 47,449 overridden alerts were included for evaluation. The appropriateness rate for overridden alerts varied by alert category (allergy: 94%, drug-drug interaction: 84%, geriatric: 57%, renal: 27%). A total of seven actual ADEs were identified in the random sample and where the medication(s) was administered (n = 366), with an increased risk of ADEs associated with inappropriately overridden alerts (p = 0.0078). Conclusions The appropriateness of medication-related clinical decision support overrides in the ICU varied substantially by the type of alert. Inappropriately overridden alerts were associated with an increased risk of ADEs compared to appropriately overridden alerts.